Identification of pulses in hormone time series using outlier detection methods.

The identification of discrete hormonal secretory pulses is of critical importance in clinical endocrinology. Pulses are defined as sudden increases in hormone concentration followed by exponential decay. We propose a model-based iterative procedure for pulse detection in pulsatile hormone time series. Our model is seen to be analogous to the model for innovation outliers in autoregressive series, and outlier detection techniques for pulse identification are adapted to the endocrine context. An original feature of the procedure is that it distinguishes between true pulses and gross observation outliers in the series. Simulation experiments are used to investigate the behaviour of the method under physiologically or clinically relevant circumstances. Five experimental endocrine series from rhesus monkeys, where the times of the pulses are known from the concomitant recording of the electrical activity of the hypothalamus, are analysed.

Does increased platelet aggregation have a prognostic value in the deterioration of background diabetic retinopathy? The Damad Study Group.

Many case-control studies have suggested that increased platelet aggregation (PA) could be involved in the pathogenesis of diabetic microangiopathy. However, longitudinal data are needed to support this hypothesis. We consider here such an approach in the placebo group (93 diabetic patients) of a controlled clinical trial on the effect of PA inhibitors in the treatment of diabetic retinopathy (Damad program). We have measured spontaneous PA and PA induced by ADP, collagen and arachidonic acid before treatment and yearly during a 3-year period. The assessment of retinopathy was based on the changes in the number of microaneurysms present in the macular field as seen on fluorescein angiograms during follow-up. PA was estimated by maximal decrease in optical density. The lowest ADP concentration still able to induce irreversible aggregation was also determined. No significant correlations between any baseline PA measurements and end point criterion were found (all correlation coefficients lower than 0.20). No significant changes in mean PA were observed during follow-up. Within-subject variation of PA was markedly large accounting for 61% to 98% of the total variance of various measurements. Allowances for the main characteristics of diabetes made no substantial difference to the results. These negative findings can be partly attributed to the lack of reliability of PA tests. In our study, we conclude that PA tests are not useful measures for the prediction of evolution of background diabetic retinopathy.

[Management of triple pregnancies]. / Prise en charge des grossesses triples.

A retrospective study of triplet pregnancies is presented. Data concerning 24 triplet pregnancies which were followed up to delivery and for a period of 11 years afterwards at the Maternity Center of the Antoine Beclere Hospital, are analysed. Early diagnosis of triplet pregnancy leads to a strong prognostic indication for prematurity. This allows time to institute preventive measures principally by reducing maternal physical activity. Because of the establishment of specific prenatal surveillance of the mothers, the rate of prematurity in triplet pregnancies be notably lowered. The mean gestational age at delivery was 33.9 weeks. The use of corticosteroid therapy between 28 and 34 weeks of gestation seems to helps prevent hyaline membrane diseases. Delivery is performed by elective cesarean section. The perinatal mortality rate was 6%.

[Pulsatile administration of GnRH: from the future to the present]. / L'administration par pompe du GnRH: du futur au présent.

Since the first clinical reports of the successful induction of ovulations and pregnancies using pulsatile administration of the neuropeptide GnRH by G. Leyendecker and L. Wildt's group in 1979, the role of the hypothalamic generator, as demonstrated in primates by E. Knobil, is widely accepted in human reproduction. During this time, an increasing number of group has experienced these therapies and there continues to be some controversies about the route of administration, the indications, the need for adjuvant therapies. A correct evaluation of these therapies needs multicentric studies and more accurate criteria: the MINITEL network provides a fast, inexpensive way to collect data from different groups and to perform studies with larger sample sizes. The Life table analysis method represents the more suitable method for evaluating and for comparing various therapy regimens. LH plasma pulsatility studies have been performed in humans in order to classify various "supra-pituitary" reproductive disorders. These studies are exposed to several methodological drawbacks and must be cautiously interpreted. Modelling is one of the new methodological issues which can give access to more physiological parameters.

Management of triplet pregnancy.

Based on the outcome of 21 triplet pregnancies from Antoine Béclère Hospital, early diagnosis in the major requirement for improving rates of fetal survival in multiple pregnancies. The outcome was better in mothers with spontaneous ovulation than in those with induced ovulations. Elective cesarean section is proposed.